P-038: PREGNANCY OUTCOMES AMONG PATIENTS WITH SICKLE CELL DISEASE IN BRAZZAVILLE.
Authors: ATIPO-TSIBA GALIBA F., ITOUA C., EHOUROSSIKA C., NGAKEGNI N., BUAMBO G., POTOKOUE MPIA S., ELIRA DOKEKIAS A.
Journal: HemaSphere (2022)

Purpose: Sickle cell disease (SCD) combines, in its homozygous form, chronic hemolytic anemia, vasoocclusive complications and susceptibility to infections. It is well known that the combination of pregnancy and SCD promotes the occurrence of complications that are sometimes fatal for the mother and/or the fetus. The objective of the current study was to compare pregnancy outcomes among women with SCD with those of no-SCD women in our country. Materials and methods: It was a case-control study carried out in the obstetrics and gynecology departments of the 4 main hospitals in the city. It was conducted over a period of 24 months (2017 – 2019). The case group was made up of pregnant women with SS homozygous SCD (n=65). The control group was made up of non-SCD gestants (Hb AA), two controls for one case. Excluded were women whose delivery time was less than 28 weeks of amenorrhea (because in our country, the resuscitation of children born before 28 weeks of gestation is extremely delicate), women admitted to the expulsion phase, or women who gave birth outside the centers mentioned above. The parameters analyzed were as follows: (i) Maternal: age, complications linked to SCD; (ii) Obstetric: gestational age (prematurity before 37 weeks of gestation), mode of delivery, postpartum complications; (iii) Fetal: birth weight (low birth weight = birth weight <2500 g), complications requiring admission to the intensive care unit, mortality. The chi-square test was used for the comparison of the proportions, the Student t-test for that of the means, and the Mann–Whitney for that of the medians. The odds ratio with the 95% confidence interval was calculated to assess the association between two variables. The p value of the probability was considered significant for a value < 0.05. Logistic regression was applied in order to identify the associated factors having a great power and to eliminate those of confusion. Results: The average age was 27 years for SCD women and 31 years for non-SCD women. The average gestational age at delivery was 35 weeks for SCD women and 38 weeks for non-SCD women. From the logistic regression analysis using the comparison group as the reference group, there was excessive risk in SCD compared to non-SCD of infection (29.3% vs. 4.6%, OR = 21.7, 95% CI [7.6–62.7]; p = 0.001), cesarean (63% vs. 35.4%, OR = 3.1, 95% CI [1.6–5.7]; p = 0.001), prematurity (75.4% vs. 30.8%, OR = 8, 95% CI [3.0–23.2]; p = 0.001), low birth weight (52.3% vs. 16.1%, OR = 4.7, 95% CI [2.4–9.4]; p = 0.001), neonatal requiring admission to the intensive care unit (40.3% vs. 17.5%, OR = 3.2, 95% CI [1.6–6.3]; p = 0.01), and neonatal death (21.5% vs. 4.8%, OR = 4.3, 95% CI [1.5–12.2]; p = 0.01). Conclusion: Maternal and fetal complications are still significantly higher in pregnant sickle cell patients. A close supervisor of these pregnancies with a multidisciplinary approach between hematologist, obstetrician, and pediatrician is essential. Information, education and communication sessions for sickle cell women are essential to minimize these risks. The authors do not declare any conflict of interest